Emergency Physician-administered Sedation for Thoracostomy in Children with Pleuropneumonia

Background: Thoracostomy drainage is sometimes required in children with pleuropneumonia who have large parapneumonic effusion. This procedure is usually performed under sedation. The aim was to report sedation adverse events (SAE) in pneumonia patients sedated for thoracostomy by pediatric emergency physicians.

Methods: A retrospective cohort study was conducted. The medical records of all emergency department (ED) patients who underwent thoracostomy between 1/1/2012 and 31/12/2018 were extracted. Study outcomes were SAE that required intervention.

Results: Pigtail catheters were placed by chest surgeons in 28 children with a median age of 2 years (Interquartile range [IQR] 1-5). All the thoracostomies were successfully performed under sedation performed by 11 pediatric emergency physicians. The median amount of fluid drained after catheter insertion was 200 ml (IQR 100-500). The median pleural fluid PH was 7.0 (IQR 6.9-7.3), and the median white blood count was 34,600 per mm³ (IQR 11,800-109,000). Thirteen (46.4%) patients were sedated with a total median dose of ketamine 3 mg/kg (IQR 2-4) and midazolam 0.2 mg/kg (IQR 0.2-0.3); 11 (39.3%) patients were treated with ketamine 1 mg/kg (IQR, 0.5-2) and propofol 3 mg/kg (IQR, 2-4). Four (14.3%) patients were treated exclusively with ketamine 4 mg/kg (IQR, 3-5). Nine oxygen desaturations required intervention; one was associated with laryngospasm and one with apnea. All the SAE were successfully managed. No cases of hypotension, bradycardia, airway obstruction or pulmonary aspiration were recorded.

Conclusions: The first series of pneumonia patients sedated for thoracostomy by pediatric emergency physicians is reported. Sedation was safely performed in this cohort.